Journal of Gorgan University of Medical Sciences

Sexual dimorphism in volume and surface anatomical parameters of cingulate cortex in normal human brains - A stereologic and macroscopic study

H.Haghir (MD)

Background&Objective: This study is designed to deteremine the sex differences in volume and surface anatomical parameters in the cingulate cortex of the left cerebral hemispheres in healthy right - handed subjects. Materials&Methods: This cross - sectional descriptive study was performed on 72 human brains (38 males, 34 females). The brains belonged to right - handed subjects who had died of non - neurologic causes. The age of males and females was similar. The brains were removed from the cranium no longer than 24 hours postmortem and were fixed in 4% formaldehyde solution. The right hemisphere of each brain was used for neuropathologic examinations (to confirm the health of the brain) and the left one was used for stereologic analyses. The estimation of the volume, surface areas, and thickness of the cingulate cortex was performed on photographs of 5 mm serial coronal sections of the left hemispheres using unbiased stereological methods (with point and linear grids). The results were analyzed by t- student test. Results: The volumes of the left cingulate cortex in males and females were 10.923.06 and 10.52.30cm3, respectively. The outer surface area was 43.8710.73 cm2 in males and 43.748.68cm2 in females. The inner surface areas in males and females were 34.8711.56 and 36.558.08cm2, respectively. There was no significant difference between two sexes in the volume and surface areas of the left cingulate cortex. The mean thickness of the left cingulate cortex in males and females were 2.880.5 and 2.510.3mm, respectively. The mean thickness of the left cingulate cortex in females was 12.85% smaller than males (P<0.05). Conclusion: Although the volume and outer and inner surface areas of the left cingulated cortex are similar between two sexes, the cortical thickness of this area in healthy right - handed females is significanlty smaller than males. The functional significance of these sexual differences and similarities in human brain is not clear. However, scientists must be aware of them in their morphometrical studies on human brain.

Effect of magnetic feild with 100µT density on rat bone resorption

S.Keshtgar (MSc)

Background&Objective: Electromagnetic fields are present everywhere in our environment with various intensities, so, investigation about their effects on living organism is very important. The aim of this experiment study to investigate the effect of magnetic field on bone resorption, PTH and calcitonin concentration and their correlations. Materials&Methods: In this experimental research, 30 Sprague-Dawley male rats were divided into 3 groups. Test group animals, were exposed to magnetic field (100µT, 50 Hz), 4 hours per day for a period of 42 days. Experimental condition for control-1 group was the same as test group, except that, they were not exposed. Animals of control-2 group were killed at the first day of experiment (day 0). Total left femoral bone calcium and phosphorus content and its fracture energy was measured at days 28 and 42 in control-1 and test group and on day 0 in control-2 group. However, serum calcium, phosphorus, PTH and calcitonin concentration were measured on day 0, the first day of exposure, and thereafter once per two weeks. Results: Total bone calcium content in test group was significantly lower than control-1 and 2 groups, and bone fracture energy showed a slightly decrease. On the other hand, serum calcium and phosphorus concentration increased significantly on 28th and 42nd days compared to day 0. There was a decrement in serum PTH concentration and increment in serum calcitonin concentration during the exposure period. Conclusion: Our results suggested that magnetic field could have a direct effect on bone resorption, and observed changes in PTH and calcitonin were in good correlation with serum calcium and phosphorus concentrations (negative feed back) and these changes also prevent further increase in bone resorption.

Effect of bisphenol A on histological structure of testis and prostate in rat

R.Ghorbani (PhD)

Background&Objective: Bisphenol A (BPA) is a xenobiotic estrogenic compound that are a monomer of some plastics (poly carbonate and epoxy resin) that are widely used in dental sealant, dishes and tableware. This compound has suspected to have estrogenic effects on reproductive system and related to endocrine disrupting chemicals. In this present study we investigated possible low dose effects of BPA on testis weight and structure and prostate weight. Materials&Methods: Male wistar rats (12-13 week old) were administrated a daily intra peritoneal 10µg/kgbw/day, 50µg/kgbw/day, 100µg/kgbw/day dose of BPA for6 and 12 days and one day after last injection testis and prostate weighted and histological section of testes prepared( 5 micrometer ) and stained by H&E and weigert hematoxilin . All data were expressed as means±SE. two-way ANOVA and chi- quire was performed. Results: in compare with control group, testis and prostate weight of dose groups were decreased. Disruptions of epithelial layer cells of semniferous tubules were detected. Conclusion: The present study showed that BPA at low doses affects histological structure and weight of testis and prostate, in the adult wistar rat.

Identification of T-cell epitopes on MPB51 antigen of Mycobacterium tuberculosis in BALB/c mice

AR.Rafiei (PhD)

Background&Objective: Both CD4+ type 1 helper (Th1) cells and CD8+ T cells play effective roles in protection against Mycobacterium tuberculosis infection. MPB51, a major mycobacterial secreted protein, induces humeral and cellular immune responses against mycobacterial infection. In addition, DNA vaccine encoding MPB51 can induce cellular immune responses and protective immunity upon challenge with M.tuberculosis. This study address to identify T-cell immunodominant epitopes on MPB51 in BALB/c mice. Materials&Methods: We cloned DNA encoding MPB51 molecule in pCI plasmid. After constructing MPB51 DNA-covered gold cartridge, BABL/c mice were immunized by using a gene gun system. Two weeks after the last immunization, the immune spleen cells were cultured in response to synthetic overlapping library peptides covering the mature MPB51 sequence or medium alone. Intracellular and cell culture supernatant gamma interferon (IFN-) production was analyzed by using flow cytometry and ELISA, respectively. Results: The findings of present study indicate that DNA vaccination can course strong mmune response only against the peptides contain 21-40 aminoacids. Further analysis with a computer – assisted algorithm permitted the identification of nine aminoacids of (P24-32) as immunodominant CD8+ T cell epitope. Conclusion: This study proved than the MHC class I-peptide (H2-Dd-P24-32) complex is recognized by (IFN-)–producing CD8+ T cells. We observed by using T-cell subset depletion that CD8+ T cells are the only P24-32-responded T-cells in BABL/c mice. The data obtained are useful for identifying cellular immune responses against TB and for designing a new vaccine against M.tuberculosis infection.

Evaluation of neurotoxic effects of lead acetat on rat radial nerve

M.Mehdizadeh (PhD)

Background&Objective: Lead toxicity is a common popular problem. Many researches were performed about this toxicity both in-vivo and in-vitro since 100 years ago.Those studies showed that lead have toxic effects such as behavioral disorders, decrease of IQ and decrease of learning and memory. Also lead has neurotoxic effects such as decrease of neuronal density in visual cortex of monkey, cell death in hippocampus and decrease of acetylcolin in rat’s hippocampus. In this study we examin neurotoxic effects of lead on rat’s radial nerve because radial nerve is a mix nerve. Materials&Methods: 24 adult male rats were divided in six groups. Groups I and II received lead acetate 4% and 2%, groups III and IV received disttiled water and normal water for one month.After this time, we killed rats and exposed radial nerve from behind of arm.Then studied them with light and electron microscopy. Results: In experimental groups we saw decrease of myelin sheath diameter and decrease of nuclear density in schwann cell. Also we saw many granules in mitochondrial matrix, active macrophage, edema and disarrangement of myelin sheath layers. Conclusion: We suggest that lead neurophaty is due to schwann cell injury and this lesion lead to decrease of myelin sheath.

Estimation of cranial capacity of Turkman’s 17-20 years old in Gorgan - North of Iran

MJ.Golalipour (PhD)

Background&Objective: It is natural that there is close relationship between cranial capacity, and the size of brain, several studies have estimated the cranial capacity which indirectly reflects the brain volume in different countries. In the present study cranial capacity has been estimated in Turkman’s 17-20 years old group in North of Iran. Materials&Methods: This study was carried out on 401 normal 17-20 years old (male 198, female 203) in South-East of Caspian Sea border (North of IRAN). By using linear dimensions of the head (Using Lee- Pearsom's Formula). Results: The mean and SD of cranial capacity in males and females were 1420.6±85 ml and, 1227.2±120 ml, respectively, this difference was significant (P<0.05). Conclusion: This investigation was shown that the cranial capacity is higher in male than female also racial and Geographical factors can affect on cranial capacity.

Effect of varicocelectomy on semen analysis parameters in patients with abnormal semen parameters

N.Moslemizadeh (MD)

Background&Objective: Varicocele represents the most common corrigible surgery in infertile men. The aim of present study was to evaluation the effect of varicocelectomy on heptads semen parameters in patients with abnormal semen parameters. Materials&Methods: This study was conducted on infertile patients who have abnormal semen analysis according to WHO parameters and to an urologist diagnosis, they have varicocele size with grade II, III, they came to infertility clinic of Imam Khomeini Hospital, Sari, Iran, 2004. The Inguinal varicocelectomy was performed over these patients by an urologist. They follow up on the basis of varicocele, post surgery complication, and semen analysis for three months. Results: 67 patients participated in this study with the mean age of 33/6±7/3 and a range of 20-50 years. The patients’s infertility range was 2-20 years, and with the mean 6/5±4/02. %58 has varicocele with grade two and %42 with grade three. In this study, the significant change in total sperm count, sperm motility, sperm morphology (P<0.05), was observed in patients before and after varicocelectomy. It hasn’t also observed any significant association between heptads semen analysis parameters and varicocele grade. Conclusion: Performing varicocelectomy could be useful improvement of semen analysis parameters and in the possible treatment of infertility in men as well.

The evaluation of fish oil (Omega-3 fatty acids) efficacy in treatment of primary dysmenorrhea in high school female students in Hamadan

M.Zamani (MD)

Background&Objective: Primary dysmenorrhea is one of the common causes of absence from work place and life quality among women. According to some studies, fish oil administration results in production of weaker prostaglandin’s (PG) and reduces the severity of dysmenorrhea. The aim of this study is to experience the efficacy of fish oil on dysmenorrhea, which is a cheap drug and with low side effects. Materials&Methods: In this clinical trial, the students separated into two groups those affected with primary dysmenorrhea by referring to girls' high schools and complete the questionnaires. In the next stage randomly were selected two groups each group included 22 students with primary dysmenorrhea. In first group fish oil capsules and the other group placebo were recommended for duration of two months. These students were evaluated before drug recommendation, at the end of two months treatment and two months afterward. In these three stages pain severity by VAS (Visual Analogue Scale) system and pain duration by Cox scaling system were be recorded in each group. Results: There is not meaningfull statistically difference in the average age, age of menarche, menstrual condition (regular or irregular) and accompaniment with symptoms of PMS (premenstrual syndrome) between fish oil and placebo groups. Before recommendation of capsules the average of pain severity did not have a meaningful statistically difference between two groups. The average pain duration also had similar situation. After two months treatment, the average of pain severity (VAS) in fish oil group was significantly less than which in placebo group (p<0.05). Also the average of pain duration in fish oil group was less than which in placebo group with a statistical difference of (p<0.05). Moreover, two months after the end of treatment the average of pain severity (VAS) and pain duration (hour) had meaningfull statistically difference between fish oil and placebo groups and were less in fish oil group. Conclusion: As compared with placebo, the fish oil capsule after two months of consumption had a significant effect on reduction of pain severity and duration in primary dismenorrhea. Also two months afterward from the end of this clinical trial the effect was more than placebo.

Impact of group and individual education of family Practice of women

A.Baniaghil (MSc)

Background&Objective: It is very important to choos a proper teaching training method to stimulate people to improve the quality and standard of their life. A proper family planing practic is one of such methods. Materials&Methods: This study is a semi-experimental research which was carried out during 2004 with the aim of comparing the two way of either indivisually or group eduction on the subsequent resuts of family planning practice among the sample populations. Sample population all were the women whome referred to the two health centers in Gorgan. 218 women were choosed by simple methods, and were divided in two groups of 109 randomly. The case and control group were trained in group and in indivisual respectively. Results: After the training of was finshed the women were asked their method of family planning of their choice. 3-6 month afterward this study was focused on the women continuation use of their choices. Collected information was recorded using a questionairs. The results were analyzed using statistic tests such as chi-squar in SPSS software. Conclusion: There was not a meaningfull differences in the efficay of either methods in this sample population, therefore it is suggested to use a group training as it is cheaper and the training is possible to be carried out by few health workers.

Relationship between depression and associated demographic factors in patients on haemodialysis

M.Modanlou (MSc)

Background&Objective: The scale of depression and the cost of prevention in some disease such as chronic renal failure is high. The present study was set up to determine the scale of depression among the haemodialysis patients. Materials&Methods: The present study a cross-sectional research. The sample population was all of the haemodialysis patients in the Golestan province (129 patients with the age group 11-77 years). The infromation gathered using, two questionairs included demographic characteristic and Beck depression inventory (BDI). Results: It showed that 37.2% of patients suffered from low to modrate depression and 31% from severe depression. Among different variable there was only significant correlation between depression and etiology of chronic renal failure (P<0.05). Conclusion: This study showed that depression is a serious problem in haemodialysis patients and a threat for their health. It is suggested that periodic psychiatric clinical examination should be carried out to have early diagnosis and subsequent treatment of haemodialysis patients.

Clinical manifestations of Hirschsprung's disease: A 6-year course review in Rasht

M.Izadi (MD)

Background&Objective: Hirschsprung's disease (H.D) is a congenital disease in which intestinal ganglionic cells are absent and can cause intestinal obstruction .The disease has various clinical manifestations and different length of bowel may be involved. Our aim was to study Hirschsprung’s clinical presentations and its rate of intestinal involvement in hospitalized patients in a 6-year course study in Rasht. The capital city of Gillan province in north of Iran. Materials&Methods: We studied the Hirschsprung’s patients referred to Poursina Referal Hospital between 1995-2001.A cross sectional descriptive- analytic study whose data was collected from patient’s files and questionnaires including demographic data, disease presentations, diagnostic methods, involved segment, surgical procedure types, surgical complications. Finally, the data was analyzed in SPSS10 software. Results: We detected 58 H.D in these 6 years, whome underwent surgery. There were 19 females and 39 males. Age of patients differed from one day to 18 year. Clinical findings were variable as follow: constipation (79.31%), abdominal distention (67.24%), inability to pass mecunium (17.24%), diarrhea (5.17%) and other less common manifestations. Pathologically, we divided our patients into 3 kinds: rectosigmoid, ultra short – segment, total – colonic. Surgeries were performed in three ways as follow Swenson - Soave - Lynn. Early complications, which come within one month after operation, contain anastomotic leakage (10.2%), prolonged constipation (10.2%). There were not any significant differences between these three types of surgical procedures. Conclusion: Majority of patients presented with a chronic course of constipation and abdominal distention. There wasn’t any difference between kinds of involvement and age and type of presentations. There are few associated anomalies in our patients. In some cases, surgical complications were less than other studies so, it is probable that our procedures had fewer complications or they had performed in appropriate time.

Relationship between duration of QRS complex in ECG and echocardiographic ejection fraction in patients with Left bundle Branch Block

F.Jalali (MD)

Background&Objective: Prolongation of QRS duration particularly in Left bundle Branch Block (LBBB) is commonly associated with many cardiac diseases. Electrocardiographic study of QRS duration and electrical axis may be predictors of sever LV systolic dysfunction. Materials&Methods: In this prospective Study conducted in cardiac ward CCU and out- patient clinic of Sh. Beheshti hospital in Babol (1999-2001), 150 patients with diagnosis of LBBB divided to two groups (one QRS≥0.16 second and the other with QRS<0.16) second . Then relationship between QRS- duration, Left axis deviation and echocardiographic LV ejection fraction analysed. Results: There wasn’t significant correlation between ages, gender, and type of cardiac disease with ejection fraction among patients with LBBB. The mean ejection Fraction in the patients with a QRS duration0.16 second (n=19) was significantly lower than the mean ejection fraction in the patients with a QRS duration<0.16 second (n=131) (P<0.05) Presence of Left axis deviation associated with LBBB did not have added predictive value and was not significantly correlated with Ejection Fraction. Conclusion: As conclusion, the QRS duration 0.16 second in the presence of LBBB has a significant inverse relation with Ejection Fraction and is a simple and appropriate marker of significant left ventricular dysfunction.

Depression during pregnancy

F.Hosaynisazi (MSc)

Background&Objective: Depression during pregnancy has been indicated as more frequent than depression after child delivery. But this important phenomenon has partly been ignored. This study aims to recognize the prevalence and possible influential factors on depression among pregnant women attended to Mirza Koochek Khan Hospital in Teheran. The study designed as a cross-sectional one and included sample of pregnant women during 2 months of study. Materials&Methods: Beck depression test was employed as data gathering instrument. Moreover, socio-economic and demographic characteristics of the respondents as well as their attitudes towards some reproductive health variables were questioned. The questionnaire piloted and thereafter, 180 pregnant women completed the questionnaire with their own consensus. Results: At least 23/3% of the sample suffered from depression in different degrees, though none of them received or requested treatment. The average score of Beck test among the sample was 11/43 with 5/75 standard deviation. Logistic regression analysis demonstrated that indicators related to physical and sexual violence from husbands’ side as well as their educational attainments were more influential variables on depression inducing (respectively). Conclusion: With regard to high prevalence of depression among the respondents, and as it has been indicated in relevant studies conducted in home, the integration of depression screening through appropriate instrument such as Beck test, in mother and child health services delivery seems to be necessary. Also taking into consideration the determinant role of husbands in rise and fall of pregnancy period depression, providing educational programs for husbands in terms of their active participation in alleviating pregnancy related problems and physiological - psychological changes occur during pregnancy suggested.

Identification and prediction of overdiagnosis of dystocia

M.Faramarzi (MSc)

Background&Objective: The Failure progress of labor is the second indication for cesarean delivery after repeat section. It is generally agreed that dystocia leading ro cesarean delivery is overdiagnosed in the world. Variability in the criteria for diagnosis is major determinant of the increase in cesarean deliveries for dystocia. This study was identified dystocia with comparison with the criteria obstetrics standards and determined the cause's effects of incorrect diagnosis. Materials&Methods: A descriptive analytic case-control study was performed on 1212 women who experienced cesarean delivery in Yahyanegad hospital of Babol a city in North of Iran during 2004. We compared criteria of diagnosis of dystocia among 248 women whome were operated with dystocia with criteria that were proposed by American college of obstetricians and gynecologis. Also, we compared 118 women with correct diagnosis with 130 women with incorrect diagnosis to identify causes of incorrect diagnosis. Statistical test 2, t-Test and multiple logistic regressions were used to analysis of data. Results: Dystocia was diagnosed during latent phase, active phase and second stage respectively: %64.9, %29.8 and %5.3. The strogenst predictor of incorrect diagnosis of dystocia was the lack of administration of oxytocine. Other independent risk factors for failure of labor to progress, using a multivariable analysis, were: performing of cesarean in morning (OR=2.8 %95 CI 2.1 –3.5), performing of cesarean in afternoon (OR = 2.6 %95 CI 1.3-3), nulliparity (OR=2.1 %95 CI 1.7-3.2), incorrect clinical estimation of fetal macrosomia (OR= 2.3 %95 CI 1.5-2.9). Conclusion: %50 accuracy of failure of labor progress according to obstetrics standards implies that there is overdiagnosis in the dystocia. This study proposes that obstetricans should be managed conservatively protract dilatation in the patients to prevent of incorrect diagnosed dystocia cesarean. Active management of labor with accurate administration of oxytocine and amniotomy is another strategy that may be help to decrease cesarean with diagnostic dystocia.

Evaluation of mental disorders’ symptoms in students of Golestan University of Medical Sciences by SCL-90-R questionnaire

Besharat S

Background&Objective: Nowadays epidemiologic paterns of the diseases are verifying rapidly non-contagious diseases like mental disorders are replacing contagious one. Several people, unaware of their psychiatric problems seek medical advise and treating. College students are susceptible to mental disorders because of their conditions. This research was done to evaluate mental health state in students of Golestan University of Medical Sciences. Materials&Methods: 218 students of Golestan University took part in this research. SCL-90-R was the test for evaluation, after collecting the questionnaires and entering into SPSS-10 software, data were analyzed with chi-square and Fisher-exact test. Results: The momental prevalence was estimated 72%. 157 persons had disorder, at least in one dimension, and 16 persons (7.34%) had severe disorder at least in one. Marriage and psychosis, paranoid & anxiety had meaningful relations (P<0.05), residental site and paranoid had meaningful relations (P<0.05), higher levels of father’s education and interpersonal sensitivity had meaningful relation (P<0.05), Family history of mental disorders, moderate interest in education, field of study and phobia had meaningful relationships (P<0.05), females had higher scores in depression (P<0.05). Conclusion: According to this high prevelence of mental disorders it seems that mental health’s problem is critically high in this region, much more attention should be paid to prevent further complications.

The effect of music on anxiety level of patients and some of physiological responses before abdominal surgery

Roohy GR

Background&Objective: Surgery is an important stressor which makes some harmful physiological reactions shuch as high blood pressure, tachycardia, and repiratory distress. The aim of this study was to investigate the effects of music on the anxiety and some of physiological responses of patients before abdominal surgery, as assessed by objective parameters and a subjective validated questionnaire. Materials&Methods: This study is a semi-experimental study. Total of 134 subjects was randomly assigned to undergo either 20 minutes of music intervention or a rest period. The level of anxiety was measured using Spilberger questionnaire and physiological responses, arterial blood presure, heart rate and respiratory rate. Subjects in intervention group listened to 20 minutes music by Johann Sebastian Bach. The control group listened to no music. The anxiety level and physiological responses were measured before and after intervention. Results: There was no significant difference between the anxiety level and physiological responses in two groups of subjects before intervention. The findings indicate a significant statistical difference in the level of anxiety and mean of arterial blood pressure in the intervention group (P<0.05). There was no significant difference in heart and respiratory rate in two groups of subjects. Conclusion: As indicated by the results of this study, music can provide an effective method of reducing potentailly harmful physiological responses arising from abdominal surgery, therefore it is suggested to use it before surgery.

Prevalence and Risk Factors of Low Back Pain in School Children Age 11-14 Years

MA.Mohseni-Bandpay (PhD)

Background&Objective: Low back pain (LBP) is common in youth, although `associated with chronic pain in adults. The purpose of this study was to determine the prevalence and risk factors of LBP in school children age 11-14. Materials&Methods: A cross sectional study was carried out on school children aged 11-14 in north of Iran. Using random multistage sampling 5000 children were selected. Demographic, mechanical and lifestyle data as well as the prevalence and LBP characteristics were collected by a questionnaire. Data analysis was carried out using SPSS (version11) software. Results: Of the original sample, 4813 (96.2%) children returned the questionnaire. Point, last month, last 6 months and annual prevalence were 15%, 14.4%, 15.6%, and 17.4%, respectively. LBP was significantly correlated with age (p<0.05), lifting (p<0.05), position and duration of watching TV, doing homework and duration of exercise (p<0.05). Conclusion: The results indicated that the prevalence of LBP in school children is relatively high. Further studies evaluating the effect of different preventive strategies to reduce the prevalence of LBP in school children is strongly recommended.

Frequency of hepatitis B virus, hepatitis C virus and Human Immunodeficiency Virus in blood donors and patients in Gorgan blood transfusion organization in 2003

V.kazeminejad (MD)

Background&Objective: Consultation prior to blood donation and screening tests of common blood born diseases such as Hepatitis B,C and AIDS are very important issue in blood quality assurance, therefore we decided to compare frequency of such diseases in blood donors and outpatients admitted in the blood transfusion centers. Materials&Methods: For this purpose the initial tests including HBsAg, HCVAb, and HIVAb were performed on all blood donors and outpatients' blood samples in Gorgan transfusion center by ELIZA methods during 2003 and confirmatory tests including neutralization for HBsAg, RIBA for HCVAb and Western blot for HIVAb performed in condition where ELIZA report was positive. Results: The blood donor in this study had the following positive results: HbsAg 2.5%, HCVAb 3%, HIV 0.35%. The same indeces for the out patients were positive as follow: 13%, 8.3% and 2.04% respectively. The other finding from this investigation indicate that the blood donors positive cases with the ELISA technique were confirmed by Western blot 92%, 20.1% nad 0% for HBSAg, HCVAb, as HIV respectively. The confimatory results of the positive out patient's cases were as follow, 97%, 47% and 60% for HBSAg, HCVAb and HIV respectivley. Conclusion: This study reveals frequency of Hepatitis B and C and AIDS among outpatients which considered being high risk group are more than the blood donors. We conclude that the measurement of HBSAg by ELIAZ methodes in comparision to the HCV and HIV are more accurate.

Six cases report of Crimean Congo Hemorrhagic Fever (CCHF) in Golestan Province of Iran

A.Abbasi (MD)

CCHF is a dreadfull zoonetic disease that is transmitted through tick bites or direct contact of infected animals, tissues or blood secretions. This virus can be seen in domestic animals and ticks. At present, CCHF exists in different areas of the world and can be consideras a health problem. The case in present report was 24 year old men, resident in Ali-Abad a town in Golestan province. He had eaten liver of infected sheep, and was suspected to CCHF according Protocol of WHO criteria to the CCHF. He was treated with Ribavirin and supportive management, and subsequently recovered. This report helps health staff to find out the risk and probable causes of disease thus controlling the spread of the disease.

Intra peritoneal hemarrhage due to gastric leiomyoma (A case report)

B.Arya (MD)

A 70- years old female referred with left upper quadrant pain since about 72 hours prior to hospital admission. In physical examination the patient was pale, hypotensive, tachycardiac and a vague left upper quadrant (LUQ) mass palpated. LUQ mass and free intraperitoneal fluid declared by ultrasound investigation there was no history of abdominal trauma and with impression of intraabdominal bleeding of unknown origin the patient underwent laparotomy. A huge fundal gastric mass identified with surrounding rupturea retroperitoneal hematoma and intraperitoneal hemorrhage. No intragatric penetration or hemorrhage was seen, so complete excision of the mass with safe margin was done with subsequent splenectomy. She had an uneventful post operative course and was discharged at the 7th post- op day. A microscopic analysis of the excised tumor demonstrated gastric leiomyoma.

Photoclinic

B.Arya (MD)

The patient was 58 years old lady, admitted due to recurrent right temporal cystic mass, with no previous histopathologic study. On physical examination, a 3*3 cm mobile, cystic mass was present with no other positive finding. Skull CT scanning revealed multilocular cystic lesion of right temporal soft tissue, without involvement of orbit, sinuses and temporal bone. Chest radiography and abdoman sonography was reported to be normal. She undergone operation of cyst evaluation and open underwent draiwage. She dishcharged after 3 days and no recurrence happened in one year follow up. Histopathologic study of the cyst contents, confimed the diagnosis of hydotid cyst. Hydatical cystis, most commonly involves the liver, then lungs and varely striated muscles may be involved at larval stage of edinococcus granulosus and rare edinococcus multilocularis, only in 3% of hydotid disease. Parasite spreads in hematogenous manner. Peritoneal, spleaic, mediastinal, renal, bone, heart, brain, muscular. Arterial, seminal vesicle involvement rarely happens. Preop sonography, CT scanning and MRI and serologic ELISA testing helps diagnosis. New method of FNA and cylologic study as noted by thial, et al may be diagnostic. Appropriate theropy is cysto-peri cystectomy or evacuation. Mebeandazole or albendazole orally as adjunct therapy before and after operation, specially when surgery is impossible may be valuable.